Tropical Veterinary Medicine and One Health: a case study of a study-abroad course with One Health principles integrated into Veterinary Medical Training

Tropical Veterinary Medicine and One Health: a case study of a study-abroad course with One Health principles integrated into Veterinary Medical Training

Margaret Loy Khaitsa^1,&, Francis Ejobi², Samuel Majalija², Gabriel Tumwine², Celsus Sente², Samuel George Okech², Patrick Vudriko², Lawrence Mugisha^1,2, David Owiny Okello^2,3, Deborah Amulen², Kokas Ikwap², Sherman Jack¹, Robert Wills¹, David Smith¹, John David Kabasa²

 

¹Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA, ²College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, PO Box 7062, Kampala, Uganda, ³Directorate of Research and Graduate Training, Makerere University, Kampala, Uganda

 

 

^&Corresponding author
Margaret Loy Khaitsa, Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, USA

 

 

 

 

One Health is “the collaborative effects of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and the environment” [1]. The American Veterinary Medical Association (AVMA) recommended that medical, veterinary and public health students be informed and engaged in the principles of One Health as part of their professional training [1]. To better integrate One Health principles into the veterinary medical science curriculum, Mississippi State University (MSSU), College of Veterinary Medicine (CVM) and Makerere University (Mak), College of Veterinary Medicine, Animal Resources & Biosecurity (COVAB) jointly developed an interdisciplinary six-credit summer elective course in Tropical Veterinary Medicine and One Health (TVM&OH) offered in Uganda. This course was modified from an earlier course offered at North Dakota State University (NDSU) [2]. The TVM&OH course covers animal health and production systems, disease surveillance, zoonotic diseases, public health and food safety systems, and issues related to livestock-human-wildlife interface using One Health approach. Recent policies in American research universities have encouraged ‘interdisciplinary creativity’, in efforts to configure research universities as engines of economic and social change [3]. TVM&OH is an innovative course that provides opportunity for United States (US) students to study tropical veterinary medicine in Uganda where rural veterinary practice is similar to many states in the US, including Mississippi. TVM&OH exposes students to tropical animal production and health systems, disease surveillance, public health systems, food safety biosurveillance and biosecurity, using the One Health approach. Additionally, the course exposes US students to Ugandan/East African culture. TVM&OH involves mainly experiential field trips in Eastern and Western Uganda. Instructors come from MSSU, Mak and partner institutions in East and Central Africa (ECA) and North America. TVM&OH is a core course for an MS, International Infectious Disease Management degree at Mak. Funding from “Capacity building in Integrated Management of Transboundary Animal Diseases and Zoonoses (CIMTRADZ)” project supported students from ECA (Kenya, Ethiopia, Tanzania Rwanda & Uganda) to study with students from the US. This joint training enhanced students´ scholarship, including learning new ways of addressing community problems from each other. This paper summarizes experiential learning opportunities offered in TVM&OH, including sample itineraries and One Health service learning activities completed by students from ECA and the US.

 

 

Tropical Veterinary Medicine and One Health (TVM&OH) course

Students successfully completing this course understand the following from Uganda perspective: 1) tropical animal production systems (livestock and wild life), 2) the unique animal health and public health challenges, 3) local and global disease surveillance systems from a perspective of a ‘foreign animal disease’ endemic country, 4) control programs for important human and animal disease epidemics, 5) public health practice, 6) food safety practice, and 7) cross cultural and multicultural environment. The course is offered every summer for 4 weeks, normally during the months of June/July. The course is available to non-MSSU students (at state tuition rate) with credit transfer. Students travel to Eastern and Western Uganda to experience different ecological zones, animal production systems, socio-economic activities and different cultures. Eastern Uganda has traditional livestock-crop farming systems with a strong livestock component, while Western Uganda offers livestock and wildlife, including the ‘special’ human-livestock-wildlife interface. During the CIMTRADZ project, the last week of TVM&OH involved student participation in international workshops (Boma) and a scientific conference organized by CIMTRADZ partners. Students presented on their experiential learning, particularly One Health activities. The international cultural Boma and conference continued in 2016 after CIMTRADZ ended in 2015. Course Evaluation was based on: participation in experiential learning field trips (25%), student reports (25%), student presentations at The International Boma/conference (25%) and on return to the US with prospective students (25%). A pre- and post-course quiz is used to assess the level of knowledge gained on the course.

Study abroad: what, why and how?

This is a pre-requisite one-credit course offered in the spring. The course objective is to prepare students for TVM&OH by providing information on a range of topics about Uganda including: animal production systems, political history, culture and peoples of Uganda and education system. Students are assigned research topics on Uganda, which they present to the class. Also, students interact and bond with other students in the TVM&OH class. Past participants share their experiences with prospective students as well.

Sample itinerary- Eastern Uganda experiential learning activities (Table 1)

The National Livestock Resources Research Institute (NaLIRRI), Tororo: students receive lectures on Tsetse transmitted Trypanosmosis: distribution of vector, epidemiology of the disease and control strategies and hands on experiential learning in the field on control of Nagana, including setting up tsetse fly traps, and practical dissection of tsetse flies.

Bukedea Livestock Market: students visit Bukedea Livestock Market - the largest transboundary livestock market in Uganda serving the neighboring coutries of Kenya and South Sudan, and observe the process of livestock trade and its role in transmission of transboundary animal diseases (TADs). Issues of food safety, antimicrobial sale and animal welfare are also evaluated.

Mbale Livestock Production Systems: students learn about livestock production systems in Mbale district, including, visits to dairy and poultry farms followed by a trip to Sipi Falls.

Bagisu People and Culture: social interaction: students visit Prof. Margaret Khaitsa´s home (TVM&OH Instructor) and get an exposure to the culture of Bagisu peoples in Eastern Uganda, through traditional dance and songs, attending traditional church service (optional), and a taste of traditional food.

Karamoja Regional Pastoral Communities: in 2015, with collaboration of the Food and Agriculture Organization (FAO), Karamoja Livestock Development Forum (KLDF), and Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), TVM&OH students visited Kotido district and learnt about the people and cultures of Karimojong, the importance of livestock to the livelihood & health (particularly status of zoonoses) of the Karimojong people, livestock markets operations and Karamoja pastoral systems. Students visited health centre leaders to learn about the healthcare systems in Kotido as well.

Soroti District: students participate in various service learning activities in the community, including: treatment and vaccinations of cattle, poultry (chicken and turkeys) and dogs; against Newcastle disease and rabies, respectively. From 2014-2016, students participated in radio talk shows with the local community to discuss the control of zoonoses, such as brucellosis. Additionally, students learnt about communal grazing systems of livestock production and its role in transmission of TADs, particularly during the dry season when animals share pastures and congregate at common watering points.

Sample Itinerary - Western Uganda Experiential Learning Activities (Table 2)

Kibale National Park (KNP): students learnt about KNP, ongoing primate research and conservation projects, biodiversity conservation and associated challenges, community livelihoods and ecotourism, and participate in field excursions - that include training in bird and rodent capture and sampling; butterfly trapping/studies; guided walk; plant diversity and traditional plant uses and primate tracking (optional).

The Queen Elizabeth Protected Area (QEPA) : this is a biosphere park spanning 4 districts of Rubirizi, Kasese, Rukungiri and Kamwenge. QEPA harbors 11 fishing enclaves, with a population of over 150,000, mostly fishermen and pastoral communities, who keep over 10,000 head of cattle within the fishing villages and in the immediate northwestern outskirts of the park. These communities live in close proximity with wild animals, competing for the available/scarce resources, e.g. grazing inside the protected area, consequently leading to human-wildlife conflicts. For instance, sometimes lions are intentionally poisoned by communities when they prey on their livestock. Case studies of human deaths from lions and crocodiles, wildlife disease issues, including ongoing transboundary disease surveillance efforts for bovine tuberculosis and foot and mouth disease, are discussed.

Large Predator Research in QEPA: Dr. Ludwig Siefert, Coordinator - Large Predator Project, and Lecturer, Makerere University together with other researchers have been monitoring the population of lions in the park for a long time, including disease outbreak investigations. Dr. Siefert shares with students his personnel experience and research findings, and future strategies to increase the population of lions in the park.

Immobilization of Wildlife Species: a brief review of physical and chemical capture of wildlife species is discussed as part of ongoing disease monitoring and surveillance projects in QEPA and a safety orientation is given. Students are then divided into two groups for immobilization exercises and given specific roles, including; performing a physical examination, and taking biological samples for disease monitoring, and each group has a lead veterinarian.

Case Study - Anthrax Outbreak in Hippos: in 2004/2005, anthrax outbreaks in QEPA killed more than 300 hippopotami and 50 buffalos [4]. Another outbreak in 2010 in QEPA lasted more than six months, killing 89 hippopotami, 8 buffalos and 1 giant forest hog [5]. Efforts undertaken to manage the outbreaks were discussed, including future strategies to monitor, predict and manage anthrax outbreaks in QEPA.

Boat Trip on Kazinga Channel: students observe wildlife by taking a boat ride on the Kazinga Channel. Vast numbers of wild animals congregate along the Kazinga Channel for water, including some of the highest densities of hippos in Africa. Students observe the diverse bird life of QEPA and communal living of buffalos, hippos and humans.

Game Drive: students get a chance to view wildlife and visit salt-licks and communal watering points within QEPA utilized by a great variety of species.

Community Conservation and Associated Complexes at the Wildlife-Livestock-Human Interface: participants travel to Katwe salt lake and visit with communities/fishing villages allowed to practice traditional fishing and keep livestock within the park, and discuss areas of conflict. Ecosystem Health Monitoring Through Environment Toxicological Assessment: students discuss pollution monitoring at Kilembe cobalt and copper mines effluent discharges on the basin of Lake George. They visit fishing villages (Hamkungu, Kasenyi, Kayanzi) and livestock communities (Muhokya and Nyakatonzi) and Salt harvesting (in Katwe). Lake Mburo National Park (LMNP): this is a small park with a high diversity of antelopes. The park is surrounded by many livestock ranches. Students learn about opportunities and management challenges facing the park management, including: 1) management of acacia hockii; 2) Trophy hunting issues of quota allocation and revenue sharing; and 3) Resource use utilization conflicts between LMNP and livestock ranchers and associated disease challenges. Where possible, students visit Nshara Ranch, a government livestock ranch near LMNP, and learn about tick borne diseases, and transmission between wildlife and domestic animals.

International Summer Research Opportunities MSSU/CVM has a summer research program for DVM students to acquire research experience. Also, the TVM&OH course is offered in summer. This presented a conflict for students interested in both programs. Now, students can complete both activities through collaborative mentorship from MSSU and Uganda, and starting the research in the spring ahead of their travel to Uganda in summer. These students typically travel to Uganda earlier (at least two weeks) before tTVM&OH course to complete their research obligations. On return to the US, these students present their findings at Summer Research Day at CVM and at the Merial-NIH National Veterinary Scholar Symposium, both held in July.

The One Health International Cultural Boma and Conference

The “One Health International Cultural Boma” and conference is an interactive two-day workshop (Boma) followed by a two-day conference that occurs during the last week of the TVM&OH course hosted by Mak, COVAB. The ‘Boma’ is an African word that means (in this context) “transfer of wisdom and knowledge from elders to the young as part of nurturing and mentoring young adults into responsible members of the community”. The cultural ‘Boma’ was, therefore, designed to mimic what happens in such a setting. The purpose of the conference is to provide opportunity for networking, sharing research output, continued mentorship and exploring opportunities for further research collaborations.

 

 

TVM&OH student enrollment (2014-2016)

In summer 2014 (3^rd June, 2014 to 3^rd July, 2014), a total of 19 multidisciplinary, multinational, multiracial graduate students of veterinary medicine and biomedical technology enrolled and successfully completed TVM&OH (Table 3). The students came from the US and five countries, in East and Central Africa (ECA); Ethiopia, Kenya, Rwanda, Tanzania and Uganda. There were 5 females and 14 males. In summer 2015, 14 veterinary and graduate students from the US and ECA enrolled in TVM&OH (Table 3). US students and ECA students were supported by MSSU, and CIMTRADZ, respectively. For three weeks, students worked together in international teams on animal production, health and foreign animal disease, including transboundary disease issues. In summer 2016, a total of 12 students participated, including 6 from MSSU, 4 from Uganda and 2 graduate students from Somalia, and were enrolled in MS-International Infectious Disease management program at Mak (Table 3).

Service learning opportunities

Mass Community Vaccinations: TVM&OH provides service learning opportunities in rural communities in Uganda with students serving while learning (Table 4). For instance, in summer 2014, TVM&OH students vaccinated poultry (chicken and turkeys) and dogs in Soroti district against Newcastle disease and rabies, respectively. In 2015, students engaged in service learning opportunities in Kotido district, including drenching and vaccination of goats and sheep against parasitic worms and Peste des petits ruminants (PPR), also known as sheep and goat plague, respectively.

One Health Brucellosis Radio Talk Show in Soroti District, Uganda: this initiative involved community education through a live radio talk show about zoonotic diseases, especially brucellosis, following an outbreak of the disease in Soroti. The participants were comprised of junior faculty, graduate students and professional students in the following disciplines: veterinary medicine, public health, biomedical laboratory technology, and microbiology from ECA and the US, The District Medical Officer, and The District Veterinary Officer, Soroti district. Participants answered questions from the local community on several aspects of brucellosis, including modes of transmission, clinical signs, prevention and control, and laboratory diagnosis. This radio talk show was facilitated by a veterinarian from a local non-governmental organization (NGO), Community Livestock Integrated Development Consultancy.

One Health Initiative to Control Trypanosomiasis, Tuberculosis and Brucellosis in Livestock and Humans in Moyo, Uganda: in summer 2016, 5 MSSU students participated in a project to control trypanosomiasis, tuberculosis and brucellosis in livestock and humans in Moyo, Uganda, in collaboration with Veterinarians Without Borders, the International Livestock Research Institute, and the National Agricultural Research Organization, Ministry of Agriculture, Animal Industry and Fisheries and Ministry of Health, Uganda. Students participated in collecting blood samples from cattle and pigs and performing respective screening tests, and educating of the community on the control of zooonoses. In Uganda, livestock are critical to economic livelihoods in rural areas. One goat can provide much needed income and determine a farmer´s ability to pay school fees or purchase required uniforms for his children. Yet TADs, such as foot-and-mouth disease, Newcastle disease, tuberculosis, trypanosomiasis, brucellosis and several other production limiting and high morbidity and mortality diseases, are endemic. These diseases hurt farmers by interrupting the livestock value chain through reproductive failure, growth, milk production and trade losses, as well as, some causing severe human disease. TADs have a negative impact on local economies, rippling through national economies, the East African region and the continent as a whole [6].

International summer research

In summer 2016, 1 student from MSSU completed both the TVM&OH course and international summer research "Longitudinal study of intestinal helminth parasite infection rates in gorillas over time" in Uganda. In spring 2016, this student; identified mentors (at MSSU) and in Uganda) at Conservation Through Public Health (CTPH), a non-governmental organization that conserves wildlife, particularly the mountain gorilla, through improving public health of communities living in proximity to national parks/protected areas. In summer 2016, the student travelled to Uganda two weeks before the TVM&OH course and shared preliminary research with CTPH collaborators in Uganda. The final research work was presented at the International Cultural Boma in Uganda, Summer Research Day at MSSU/CVM and at Merial-NIH National Veterinary Scholars Symposium held July 28-31, 2016 in Columbus, Ohio, USA.

Networking & Partnerships Development

The TVM&OH course normally ends with an international workshop (Boma) and conference organized by CIMTRADZ partners where students attend workshops and seminars and present on their experiential learning while highlighting One Health principles learnt. In both 2014 and 2015, at the end of the TVM&OH course, students participated in workshops and professional meetings attended by faculty from CIMTRADZ participating institutions in ECA and from the US and Canada. The ‘International Cultural Boma’ and conference provideed opportunity for networking, sharing research output, continued mentorship and exploring opportunities for further research collaborations. After the course, students continued to interact with peers by use of emails and social media, such as WhatsApp and Facebook.

Sample Testimonies of student participants in TVM&OH Courses

While the main focus of TVM&OH is to give students One Health experiences, students also gain positive life experiences, including cultural exposure. Robert Stenger, a second-year veterinary medicine student, participated in the course in 2016.

“The things we did and saw while there were incredible and eye-opening,” said Stenger, who is President, International Veterinary Students Association. “We witnessed the challenges these people have related to food security and the problems facing us as veterinarians and scientists. In Uganda, people can grow a lot of food crops, and still be malnourished because their protein sources are scarce. To have protein in their diets, they have to raise livestock in their backyards or enter wild animals´ habitats to hunt or fish. In both instances, they have potential to spread disease to animals or catch diseases from animals,” Stenger said. During his trip, Stenger also participated in collaborative research with “Conservation Through Public Health” an NGO that conserves endangered mountain gorillas at Bwindi National Park. “The picture most people have of Africa in their mind´s eye is not the reality,” Stenger said. “We learned so much more than the veterinary and health-related information we went for. International study, in Africa or in other places, can positively impact you as a global citizen”.

“The dairy farm was a great experience for us,” said Victoria Hall, a 2014 participant. “The farm was no larger than a quarter-acre with five dairy cows managed permanently in stalls. We were challenged to think about waste disposal, use of biogas, possible stream and river contamination, diet, water intake needs, and so much more”.

Jodi Richardson, a DVM student with a Master of Public Health, said she enjoyed the community education and the collaboration with ECA students and scientists. “By being able to travel the area with people who live and work there, we were able to better understand the challenges they face,” Richardson said. “I really enjoyed the community outreach we did by vaccinating dogs against rabies and chickens against New Castle disease, and deworming cattle”.

Students participated in a call-in radio program in Soroti, Uganda, to educate people about brucellosis, a bacterial disease that affects humans and animals. “This was one of the highlights of the trip for me,” stated Richardson. “Anytime I can help educate people about an area of veterinary medicine that is going to make their life more fruitful, such as ways to protect themselves and their animals from disease, I feel like I am doing my part to help.”

A participant of the 2014 and 2016 course, Ryan Taylor said “We had many chances to talk about how wildlife may play a role in transferring diseases between humans and animals, such as closely related species, like chimpanzees.”

“Experiencing the culture was amazing,” said Katy Fogt, a 2014 participant. “One of the highlights for me was visiting Dr. Khaitsa´s village. It was incredible to be welcomed into their church and community. After lunch, we played with the children and danced.”

Challenges

The most significant challenge regarding the TVM&OH course is the financial costs, especially international travel. The total cost of the TVM&OH course, including credit, is approximately $7,500USD (including travel ($1,800 to $2,200USD); program fees, including food, accommodation and local transportation ($4,500USD); tuition ($1,800USD); and non-program related costs (varies per student). Students pay for the course using personal funds or loans and travel scholarships from MSSU/CVM. This cost is prohibitive to several students that wish to participate but cannot afford it. Other challenges reported include: skepticism from parents and some students with regard to factors, such as; safety and health concerns, cultural shock, fear of social integration, homesickness, language barrier, fear of the unknown, sustainability, time and climate differences and competing summer activities (including job opportunities and family commitments) [2]. These concerns are addressed in several ways including: information sharing during the pre-requisite course offered in spring, past students and parents of past students and "study abroad student ambassadors" sharing their experiences with prospective students and helping with recruitment efforts.

 

 

The TVM&OH course has benefitted students in several ways, including providing an opportunity for students from several countries to interact, and as a result, develop cultural sensitivity, which is vital for the global job market. The Association of American Colleges and Universities (AAC&U) reports that companies prefer to hire professionals that have a cross-cultural exposure [7], as compared to those that do not. Also, there is evidence that through experiential learning, students´ critical thinking and problem solving skills are enhanced in the process [8]. Additionally, the multi-disciplinary aspect of the course enables students to appreciate the integrated approach to disease prevention and control, which promotes One Health. By conducting service learning projects in the communities, students get an opportunity to address real life problems while learning [9]. For example, at Queen Elizabeth and Lake Mburo national parks, students learn about the conflicts the local communities face in protecting agricultural produce from wild-life and conservation efforts implemented by park management. Other benefits of the course include: tourism, improved communication skills, changed stereotypes, and development of lasting international friendships. Students have described the course as a life changing experience. Indeed, TVM&OH training advances the US Food, Agricultural, and Natural Resources Management as shown in Table 5. As the need for increased global food and agricultural scientists is addressed, international learning experiences are becoming critical to student education [10]. An international experience helps create an awareness of international perspectives and prepares students for a global workforce [8]. Possessing agricultural knowledge in addition to international experience is considered an advantage by employers [11, 12]. Additionally, international learning experiences broaden cultural awareness [8]; combining cultural awareness with experiential learning about agricultural practices provides an opportunity for students to develop higher order thinking and problem solving skills, which is often seen as a valuable experience for future employers [13]. To effectively train the next generation of agricultural professionals, universities must provide an education that recognizes the global nature of today´s societies and develops the skills needed to address issues that are diverse and complex [14]. Additionally, universities must find innovative ways to address barriers [15] to student international experiences.

 

 

The TVM&OH course provides scholars with professional competencies (problem solving, service learning, teamwork, research, community engagement and policy development) that enable them to solve complex problems in real-world situations. The course curriculum supports the US´s academic competitiveness in the Food, Agricultural and Natural Resources management. Students successfully completing this course contribute to an open minded world class, broadly inclusive and globally engaged science workforce. The course provides a foundation for tomorrow´s global citizens that understand and appreciate food security, safety and public health from a global perspective. It provides for global career development opportunities, fostering an international perspective and ability to work and understand diverse animal production, food safety and public health systems. Graduates of the course recognize and understand cross cultural differences and multicultural environments. Indeed, TVM&OH training advances the US Food, Agricultural, and Natural Resources Management.

 

 

The authors declare no competing interest.

 

 

All authors contributed to writing drafts of the article, reviewed several drafts, provided important intellectual content, and approved the version to be published. Additionally, all authors participated in curriculum development and/or were instructors in the TVM&OH course. All authors have read and agreed to the final version of this manuscript.

 

 

The authors wish to acknowledge financial support provided by the USAID under The Africa-US Higher Education Initiative of ACE, APLU and HED through the CIMTRADZ project.

 

 

Table 1: sample itinerary- Tropical Veterinary Medicine and One Health: Eastern Uganda Route (Livestock Production Systems, Animal Health, Food Safety and Public Health)

Table 2: sample itinerary- Tropical Veterinary Medicine and One Health: Western Uganda Route (Wildlife & Ecosystem Health Experience)

Table 3: list of TVM&OH student enrollment; summer 2014-2016

Table 4: Tropical Veterinary Medicine & One Health sample activities

Table 5: sample of previous participants of Tropical Veterinary Medicine & One Health course and Current Career Status

 

 

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